10
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Strategies to Improve Management of Acute Watery Diarrhea during a Military Deployment: A Cost Effectiveness Analysis

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract.

          To inform policy and decision makers, a cost-effectiveness model was developed to predict the cost-effectiveness of implementing two hypothetical management strategies separately and concurrently on the mitigation of deployment-associated travelers’ diarrhea (TD) burden. The first management strategy aimed to increase the likelihood that a deployed service member with TD will seek medical care earlier in the disease course compared with current patterns; the second strategy aimed to optimize provider treatment practices through the implementation of a Department of Defense Clinical Practice Guideline. Outcome measures selected to compare management strategies were duty days lost averted (DDL-averted) and a cost effectiveness ratio (CER) of cost per DDL-averted (USD/DDL-averted). Increasing health care and by seeking it more often and earlier in the disease course as a stand-alone management strategy produced more DDL (worse) than the base case (up to 8,898 DDL-gained per year) at an increased cost to the Department of Defense (CER $193). Increasing provider use of an optimal evidence-based treatment algorithm through Clinical Practice Guidelines prevented 5,299 DDL per year with overall cost savings (CER −$74). A combination of both strategies produced the greatest gain in DDL-averted (6,887) with a modest cost increase (CER $118). The application of this model demonstrates that changes in TD management during deployment can be implemented to reduce DDL with likely favorable impacts on mission capability and individual health readiness. The hypothetical combination strategy evaluated prevents the most DDL compared with current practice and is associated with a modest cost increase.

          Related collections

          Most cited references21

          • Record: found
          • Abstract: found
          • Article: not found

          ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults.

          Acute diarrheal infections are a common health problem globally and among both individuals in the United States and traveling to developing world countries. Multiple modalities including antibiotic and non-antibiotic therapies have been used to address these common infections. Information on treatment, prevention, diagnostics, and the consequences of acute diarrhea infection has emerged and helps to inform clinical management. In this ACG Clinical Guideline, the authors present an evidence-based approach to diagnosis, prevention, and treatment of acute diarrhea infection in both US-based and travel settings.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Global etiology of travelers' diarrhea: systematic review from 1973 to the present.

            Fifty-one published studies of travelers' diarrhea (TD) were examined to look for regional differences in pathogens identified. Enterotoxigenic E. coli was detected in 1,678/5,518 (30.4%) of TD cases overall, with rates in Latin America/Caribbean (L. America), Africa, south Asia, and Southeast Asia of 1,109/3,302 (33.6%), 389/1,217 (31.2%), 153/499 (30.6%), and 36/500 (7.2%), respectively (P < 0.001). Enteroaggregative E. coli was the second most common agent in L. America, found in 166/689 (24.1%), compared with 3/165 (1.8%) in Africa and 33/206 (16%) in south Asia (P < 0.001). Other significantly regional differences were seen for enteropathogenic E. coli, diffusely adherent E. coli, Campylobacter, Shigella spp., Salmonella, Aeromonas spp., Plesiomonas, Vibrios, rotavirus, noroviruses, Giardia, and Entoamoeba histolytica. The regional differences in pathogen identification identified will serve as a baseline for antimicrobial therapy recommendations and vaccines strategies.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              High Rate of Acquisition but Short Duration of Carriage of Multidrug-Resistant Enterobacteriaceae After Travel to the Tropics.

              Multidrug-resistant Enterobacteriaceae (MRE) are widespread in the community, especially in tropical regions. Travelers are at risk of acquiring MRE in these regions, but the precise extent of the problem is not known.
                Bookmark

                Author and article information

                Journal
                Am J Trop Med Hyg
                Am. J. Trop. Med. Hyg
                tpmd
                tropmed
                The American Journal of Tropical Medicine and Hygiene
                The American Society of Tropical Medicine and Hygiene
                0002-9637
                1476-1645
                06 December 2017
                25 September 2017
                25 September 2017
                : 97
                : 6
                : 1857-1866
                Affiliations
                [1 ]Uniformed Services University of the Health Sciences, Bethesda, Maryland;
                [2 ]Naval Medical Research Center, Silver Spring, Maryland
                Author notes
                [* ]Address correspondence to Mark S. Riddle, Enteric Diseases Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910. E-mail: mark.s.riddle10.mil@ 123456mail.mil

                Authors’ addresses: Andrew J. Schrader and David R. Tribble, Uniformed Services University of the Health Sciences, Preventive Medicine and Biostatistics, Bethesda, MD, E-mails: andrew.j.schrader.mil@ 123456mail.mil and dtribble@ 123456idcrp.org . Mark S. Riddle, NMRC, Enteric Disease Department, Silver Spring, MD, and Uniformed Services University of the Health Sciences, Preventive Medicine and Biostatistics, Bethesda, MD, E-mail: mark.riddle@ 123456usuhs.edu .

                Copyright statement: Authors are employees of the U.S. Government and military service members. This work was prepared as part of official duties. Title 17 U.S.C. §105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

                Article
                tpmd170196
                10.4269/ajtmh.17-0196
                5805040
                29016296
                1bb25988-358a-4eee-9ee7-9098b12fc163
                © The American Society of Tropical Medicine and Hygiene

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 March 2017
                : 14 August 2017
                Page count
                Pages: 10
                Categories
                Articles

                Infectious disease & Microbiology
                Infectious disease & Microbiology

                Comments

                Comment on this article